HomeMy Public PortalAbout6121-6135 GOLDEN WEST AVE_Mechanical__ AOR'KERS'COMPENSATION'DECLARATION - CE-818 (2-80Y APP LAC Y�l`I FO •,� U�U.PT
I herelh aftirii'.that I have a certificate of-consent to self --,i r*_ ;�,� °• - a 1
'insure, or a certificate of Workers',Compensation Insuradce,or !t ' °n _ ��EATiNGW EN��������.��� �Q�®1�������e`
a.certified>copy thereof(See-3800',>Lati"C.)
OTICNO � 's. 'r,. _w:-{'�+,';r. •r i �-, ,� �� -f �s �,� .
Y Company ,. t �• k
P sift ied�c is COUNTY-OF�LOS-ANGE,LES,� r��• s - 3_'BUIL�DkiUGrARiD'SA'FETV
'C f opy hefetiy"furnished`. , -lv _ K
Certified copy_is'filed`with the county'.buildm9 mspectiori > �
de artment' _, `FOR'°APPLICAN TFfiQ-FiL'L'IN," Bu1LDIN,G
P (PRI�NoT OR TYPE ONLY ADDRESS
Date' Applicant-- co
LOCALITY
,CERTIFICATE OF EXEMPTION FROM,WORKERS'` •NO'' ' .�TYPE�bF�X FiLIIANCE OR E'OUIPMENT r FEE',`
COMPENSATION,INSU,RANCE '' f `�- i. z ; .NEAREST _ 7'.
„ r >i"`�
(This section need not-be completed--if athe>,work involved" 'r„p ABSORPTION UNIT,.BTtJ _ i CROSS ST'
by the;permit' is for one hundred dollars ($100)"ot less.),”' /'� r~ DISTRICT•NO _ PROCESS ?BY
I-certify that•in'the-performance of'the work for,whCich this AIR HAND°LING,UMT',`CFM�(L_ / — by CC
permlt�is'-issued; I,shall-
nqt employ an'y erson in any_manner� d. ��
'r s`0 as to.tiecome suliject�to the W rker Co nsation'Laivs'. BOILE8, BTU �
� APPROVALS DATE INSPECTOR'S SIGNATURI; (U
Date LU
Applicant_ ��> COMPRESSOR, BTU U-
Exemption; - d '
NOTICE TO APPLICANT! If, atter�making This Cer ficate of, " VENTIL'QTiON'SYSTEM ` -0 Z
y,ou'sh'ould become subject to alis= Workers'-
'ROUGH
�r •,
Compensation provisions,of'the"Laboi-Code'you'inust forth__`--, a t , , n
'with comply -with °such provisions or this permit shall° be ., 'EVQPORATIV�E COOL'ER�^�: :� VALIDATION" f �
deemed revoked. ° ° FURNACE ,'FAU GRAVITY -
LICENSED CONTR'AC.T`ORS DECLARATION � FLOOR:> _13TU'
I hereby affirm that I am lioensed under provisions•of Chapfer HEATER. SUSPENDE(5 UNIT
9 (commencing with Section 7000)of"Division+3 of-the Busi=, WALL"
nness and Professions Code, and'iny license isin'full.force and,
^effect > _
License Number Lie Class
Contractor Date- z "
I,am exempt from ttie licensing reyuir'ementi as'l am a
licensed,'architect, or a•re stered professional en'mee 3
vi p g Plan check'fee_25%of,atiove. "
acting,in my ,professional capacity.(Section 7051 Bus-,
mess and Professions Cone);_ FE RMI T.ISSUING FEE $
Lie.or'Reg.No'• Date - d v ",TO AL FEE
HOME OWNER-BU ILD ER-DECLARATION PLAN CHECK,APPL-ICANT ;° -
Iheieby„affkm that'I•am exempt from-'the' Contractor's NAME
-L
icense`L"aw°for the following reasoA (Section 7,031.5, Busi-r`
ne-ss,and Professions Code)- _e ADDRESS t
>] -I, as owner of the property, will do"the work'apd-the _ i NO. r ¢
structure is not intended'or offered for, sale'(See CITY-' TEL. NO.
7044,Business and Professions Code). R,
' o �> <t d -,_ DWNEa`' � Ot;l. &. - A
aswner,of the property,-am=exclusively,•coritractmg �� " -' i t� '`•
with licensed' cont?actors to eonsiruct7, the project MAIL, " n {��#�b'a ore 1"8 e,
(Section7044,°Business and Profes`sioi7s Code}. ' ADDRESS> _
A,',CpNSTRUCTION LENDING AGE
- �- CITY TEL NO� � � " aF
r,
I hereby--affirm.that there.is a construction leng,dinagency. '� x
for the performance of-the work`foi which this,peir it"is CONTRACT e;olq,'� p_pci.- .
issued Sec:,3097,Civ C:) f, 1 "
:Lender s Name' •ADDRESS a a ,� 7.0 2a"'y8p�
Lenders Address CITY'' a •" TEL Nb`' ��
I certify°'that I have,read this application and state that theL'IC.; _ •' �'_���'
STATE"
above information is correct:'Lagree to ct)omply with all CounLICENSE NO. CLASS'?
ordinances and State laws regulating fieatm Ventilati_n and ' =
g: hereby g p g g -SEE REVERSEYOR EXPLANATORY LANGUAGE
- Air'Conditioning,and hereb authorize re resentatives of this
_County o ter p the above-mentioned- property foi' g'
'n. on p pose
gnature Permit
oftee -Date 'ti